Individual
KRISTEN RENEE JESSEE-BREEDING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
16431 WISE ST., ST. PAUL, VA 24283-0000
(276) 762-2300
(276) 762-0612
Mailing address
16431 WISE STREET, SAINT PAUL, VA 24283
(276) 762-2300
(276) 762-0612
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110002222
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720006000
—
VA
01
—
TN01A5
JOHN DEERE TENNCARE
TN
Enumeration date
07/17/2006
Last updated
01/12/2022
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